Tonsillotome



D'ec. 27, 1927.

A. E. FINGERHUT TONSILLOTOME Filed Deo.

2 Sheets-Sheet; 2

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yUNITED).STA'IES ALEC E.` FINGERI-IUT, OF CLVELAND, OI-II.

TONSILLOTOME.

Application led December 27, 1926. Serial No. 157,044.

rll`his invention as'indicated` relates to an improvement in surgical instrun'ients and particularly in a device known as a tonsillotome. The instrument is intended especially for the rcmovalot' the tonsils although its use is not intend-ed to be restricted solely to the tissues referred to but may be applied, within the scope of the claims, to the removal ot other diseased portions or" the body.4

ln the operation ci" removing' diseased tonsils, it is desirable to compress the pillars or supporting; tissues to prevent subsequent hemorrl'iagge from the associated `blood vesf sels, and, while thus holding' such attaching members firmly, to `sever the diseased tonsil by an operation ot the instrument readily carried on by the same ,gripping movement which compressed the pillars. In devices heretofore used tor tonsillotomy, separate means tor clamping' the pillars and for severing the diseased tonsils are provided and these means are often controlled with diiiiculty and necessitate the operator changing his position at the criticalv time oi the operation. y

The present invention has in view the ob- `vint-ing` oit the difficulties referred to and the provision ot an instrument which by a simple gripping movement will serve to .clamp and lock the diseased tonsil iirmly within the aperture ot' the device and which by a simple, readily accessible v'adjustment within the reach of the thumb of the operator will permit a turther n'ioven'ient of the actuating lever to be made which will carry the cutting blade through the adjacent tissue.

ln addition to the features just mentioned, the device is provided with a release which is instantaneous in action and requires no careful adjustment to become immediately effective.

'lo the accoz'nplisliment ot the foregoing and related ends, said invention, then consists ot the means hereinafter tully described und particularly pointed out in the claims.

The annexed drawing' and the following description set forth in detail certain mechanism embodying` the invention, suoli disclosed means constituting, howeveiybut one otvarions mechanical forms in which the principle oi the invention may be used.

.ln said annexed drawing:

Fig. l is a side elevationot an instrument embodying the principles of my invention; Fig. 2 is a central vertical sectional view showing the upper portion oi said instru ment; Fig. 3 is an enlarged vertical Sectional view showing,- the trigger mechanism with its upper end in its forward position ot adjustment; Fig. ,i is a horizontal sectional view taken immediately above the clamping` bar; F ig. 5 is a top plan viewot the clamping` bar; Fig. 6 is a. top plan View of the cutting bar; Fig. 7 is an enlarged detail view partly in section showinp; the receptacle for the severed tissue; F ig. 8 is an end elevation of the structure shown in Fig. V7; and Fig. 9 is a fragmentary plan view of the forward end of the instrument showing a. modified form of opening. f y

its is clearly shown in the drawing, the instrument comprises a body member l having;` a` rearwardly extending' handle portion 2, formed integrally therewith. Said handle portion is shaped at its lower end to `fit the curvature ot the hand of the user and a rearvard extension 3 is formed to engage above the thumb of the opera-tor. The upper portion ot the body member `terminates in a horizontal extending upper edge 4 provided with lateral flanges 5, and formed with a smooth top surface. The body member is open centrally to its upper edge to receiveV the upper end of an operating; ent-ly to be described.

An 'elongated iframe member 6 is adapted to be engaged upon the upper surface of the lever presbody member being suitably recessed to lit over the margins thereof.A Said frame member provided with an elongated central openingof somewhat lgreater diameter at its projecting forward portion than its rearward portion which tits upon the body member.

.lhe forward end 7 of the frame member is adapted to form one portion of the clamping device, the other portion comprising' a clampingl bar S, which with a cutting bar or knife 9, is adapted to be sldingly supported on the upper surface of the body member.

The clamping bar, as shown in Fig.` 5, comprises a metal plate ot' slightly larger diameter adjacent the forward end llthan over its main bot y portion 19,. The bar is provided with a threaded extension Stem @13 lirmly secured to its'rearward end by any suitable means such as brazingor welding or by means of a driving fit. At a point slightly in advance of the point of juncture of the stem with the plate portion of the screw-threaded extension, a slot 14 is provided which. may be regarded as torined ot two parallel spaced slots with an intermediate `elotljoining the two at their rearward portions so as to present an irregular opening having a rearwardly.projecting lutti lat its forward end, and a rearwardly extending slot 1G at its rearward end. The clamping bar reterred Vto is adapted to lit within the tralnemember which ae stated recessed on its under side,4 thus providing` a. portion' to overlie the topfsur'lace ol the hodv melnberfwith marginal Hangers to engage over'thelateral 'flanges ol the hotly member and hold said 'traine in place. 'lhe traine thus `provide` a .elideway tol" the clamping bar and kniie and ita 'ttn'ward edge providerJ the abutment toward which said slidable members move `to efiect their several functions. The rearward end of the vtrame is enlarged and joined with a. portion 17 ot cylindrical croas-ae`tion in order to provide a suitable houaing 'tor a lSplit nut control devicelS for the clamping har. p rplit nut portion o'tthe apparatus i-s mounted on a cap 21 having a circumferential flange 22 adapted telit. overthe cylindrical rearward'end et the traine.` Centrally ol the cap a cylindrical extension 23 is rigidly `secured which is centrally `apertured to receivethreaded extension ot the clamping` har and which ie traneverselySlotted toprovide working.t space Ltor the Scre\vthreaded jaws 24 oil the split nut. rlh-e jawnl ot the split nut at their 'forward edgeff, are provided with outwardlT extending rain ineinbers Q5 and at theiroppo-site ends are provided with einiilar cam niemhere QG. The two parte ot the split nut are pivotcd to the ca p extension adjacent their central` portiona. 'lhelength of the Split nut Vmembere .ia slightly `greater than that oi a reduced c vlindrical opening 2T 'formed in the 'trame which accomi'nodates the forward end ol the cap extension. Thus when the split nut in engaged with the Screw threads of theeteni, the cam exten-sions thereon will Slide within the cylindrical opening. lVhen. however. the cap meniher is moved forwardly toward the rearward end of the trame,` the rearward cam members on the split nut will he. brought into contact with the rearward lacea ol" the eifliiulrieal opening and will positivelynlove the threaded forward or ffri i iin@ iortion o't the lQplit nut away Atrono the threaded portion ot' the stem n'ieinber. permitting' the smooth cut awa)1 rearward portions ot the splitnut to overlie thethrcaded stem. In order to normally hold the split'nut in engagement with the threadS ot' the clamping' har, a spring` 3l is provided in the Space between the. flange on the cap and anfenlargement 32 at the hase ot the cylindrical extension, said spring `at its opposite ends heine engaged against the rearward face 33 ol the cylindrical` portion ot the iframe. Thus the cap is normally preaaed rearwardly The A andthe lorward 'ani nlelnhere ot the aplit nut hold 1t in engagement with the stein.

. Byrotating the cap the clamping har may be moved toany desired position, thus,I

changing the size el the openingjir through vthe forward end ot the instriunent.

threaded stein extension, however, the knile is tol-ined without any extension whatsoever. hut is provided adjacent its rearward end with a slot 36 somewhat similar in outline to the slot formed through therearward end of the clamping har. Said slot, however. h;

to he distinguished ilroi'n the slot in the f zlainping;r bar in that its rearwardly extend ing' tongue 2:7 ie ot leaner depth than that in the clamping har and its rearward `eateneion slot` 38 is of greater depth. The purpoee et the dilt'erence in the openine'e in the respective clamping end cutting hars w1ll be presently described. The irnrward portion oit the knife provided with a keen cutting edge 39.

A. housing; 4-1 ot sheet metal open adplcent ite rearward under .eide and having; an aper ture l2 corresponding with the desired operating Space of the instrument, provided to torni the outer casing il'or the upper nlechanism ot the instrument. The shape ol the opening may be rectangular as shown in Fig. Ll. or may he rectangular aa to `three .aides and curved at its liorward edge which in the preferred Ytorni oi conetruetion. and Shown in Fig. 9. Where the aperture has a curved Forward edge. it is in Cnary to have the ,traine ineinher and verward end oit the canineY #ifi shaped similarlyr as well ne to provide a curved ttorwardedge Ll1-l; on the cute tine' blade and clamping' har.

The housing, as stated, is lelottcd on ite under side adjacent its rearward end to per mit the 'alne to be moved hacliwardly over thelateral flanges on the hody member. A pair ot care` l5 is inovided adjacent tht` rearward end ot the housing `which are auilahly aperlured to receive a securing holt slli. The holt may he lornied with an enlarged head (not. shown) to serveaea Stud or linger ri-ip to be engaged hy the lorelinger ot the operator in pressing the, cap forwardly with the thumb. It will he placed on the right or lett hand side of the `instrument according to whether the Surgeon uses his right or lett hand. f i

The rearward portion @t7 oil. the housing is made cylindrical vin shape so as to engage over the cylindrical portionot the iframe. The forward end oit' the housing may he prorided on ite under aide with an extension titl lill? same from falling1 into the throatand Causing; strangulation.

The trigger portion of the apparatus will now be described. rlhe handle portion of the device as has been indicated comprises a rearward extension formed rigidly with the body member, which supports the clamping bar and sliding knife. As stated, it is provided with a rearwardly projecting,` finger which serves as an abutment for the thumb of the .instrument engaging hand of the operator so that a firm grip may be had when the trigger is to be operated. The trigger portion of the device comprises a lever 5l provided with an open loop 52 adapted preferably to receive four fingers of normal size and having a pair of spaced projecting bars or lingers 53 at its ripper' end. A pivot pin 5ft for the trigger is engaged through suitable openings in the lever and body member. The extension fingers atk the upper end of the trigger are spaced from each other a distance equal to the spacing` of the outer portions of the slots in the clamping)` bar and knife heretofore described. An intermediate finger is provided between those first descrilied and is pivoted centrally on the first pin of the lever. Said intermediate finger is provided with a segmental enlargement 5o at its iirtermediate point with a notch 57 having` a flat face at its forward side and a curved rearward face. Said notch is adapted to be eng" ged when set in proper position by a portion pf the semi-cylindrical central portion (il of a locking bar 62 engaged through the body portion of the lever 5l. Said pin at its outer end .is provided with an operating;1 lever G3 which terminates in a button or thumb piece 64; of any desired shape. Said thumb piece carries on its under side a detent (not shown) which is adaptedto ride into slight depressions G5 at either end of an arcuate groove 66 defining' its path of movement on the handle adjacent the point of support of the trigger. Thus when the control lever is positioned in its upper adjustment. the intermediate linger or extension on the trigger will be locked in slightly forward position with respect. to its adjacent lingers. lil/Then so locked the trigger .when moved will force the central finger against the rearwardly extending lug,r of the clampingr platD and knife "to move the sa1ne`forwardly. Then the lugs are so positioned, the knife edge will be spaced and securely locked a i .iroximatel one-eio'hth of an inch to the rear of the front edge of the clamping bar and there, therefore, will be no cutting action whatsoever. lVhile the fingers are adjiusted as stated, the lateral lingers will be eng-aged in the respective lateral slet portions of the openings through the clamp- L7:5l interengagg'ing at their upper enc .ing bar and knife respectively, said fingers engaging the "rearward portions of the clamping)r bar slots and the forward portions of the knife lateral slots.

The lever 5l isV normally held with its upper end rearward and its'lower end forward by, means of `a pair of leaf v`springs 7l, ls and having their lower ends respectively secured to the inside faces of the Vhandle and lever. In the position `just described, the apparatus ready to be engaged over a tonsil and moved into clamping `engagement with the pillars of the same. The threaded portion of the split nut will be opened by the forward movement of the clamping bar and will lock as soon as the pressure is released.

Therefore the clamnincr bar mai be forced J. g5

into locking engagement with the tissues which it compresses. lfilhcn the desired clamping action has been obtained, the surgeon is ready to move the knife to sever the diseased tonsil and this is accomplished by turn the pivoted bar through approximately a-nangle of 900 and thus rel-easing` the central linger from. locking` relation to the lateral lingers. lV hen so released, the centrallinger 4 ysever the tonsil from its supporting:y tissue.

moving the thumb piece downwardly to its, extreme limit of motion which will serve to rlhus the action of moving the clamping` bar against the tonsil and the moving of the knife to sever the tonsil so clamped is aecomplished by successive movement in a single direction. After severing the tonsil where the instrument is provided with a receptacle as heretofore described, the severed tissue will be securely held within the receptacle and no danger of strangulation occurs. It is therefore possible to maintain the clamping "engagement with the severed tissues for a brief period of time after the operation has been completed. This hasthe advantage of sealing the edges of the severed tissue and reducing;` the usual hemorrhage which takes place 1n such opi-nations to a nnninfunn.

lifter the compression upon the adjacent tissues has proceeded for the additional time desired by the operating` surgeon, the cap is forced forwardly so as to spread thc two sections of the split nutnnd release the clamping; bar. The latter will be moved freely backward as soon as the members of the split nut spread apart and release the screw-threaded stem.

Other modes of applying the principle of my invention mayA be employed instead of the one explained, change being made as regards the mechanism herein disclosed, prolit) `means Within Ytion tor clamping said obicct, means asso- Las videdtlie means stated by any of the following claims or the equivalent of such stated means be'employed. .p

Itheretore particularly point out and distinctly claim as my invention: L

l. An articleot the `character described, having in combination a `handle portion and a laterally extending section, an aperture in saidlateral extending section adapted to be engaged over an object to be ampntated,

said laterally extending porciated with said clamping meansfon severing said object, and unitari7 means associatr ed ivith said handle tor selectivelyT operating said clamping and severing means in combination or said severing means inde pendentliT by successive movement in a siir gie direction.

2. iin article oi the character described having in combination an elongated member provided With clamping means and tissue severing means and means for selectively operating said clamping and severing means together or one .of said means separately by successive movement in a single direction. l

3. An article of the character described having in combination an elongated member provided with clamping means and tissue severing means, means for selectively operating said clamping and severing means together' or one ot said means separately bv successive movement in a single direction, and means adjacent said severing means ior receiving said severed tissue. l i

il An article of the character described having in combination" an aperture adapted to engage over the object to be operated upon, a clamping member and a severing member slidably engaged Within said apertnreil member, means iter automatically holding said clamping means in locked engagement with the tissues to be severed, means for moving saidiclamping means forwardly and means for selectively moving said cutting means forwardly1 independently` of said clamping means by successive movement in a single direction.

An apparatus oi. the character described, having in eoniifiination a iframe, a cutting member aiula clamping member asso* relation to each other, means associated "with said levertor disconnecting said claininng means from said cutting means bv sucer sive moven'ient ot said lever in a singledirection, and pern'iitting the independent operation ol said cutting means.

(i. An apparatus of the character de scribed, having in combination a iframe, a cutting member and a clamliing mendaci as seciated with said iframe, a lever tor actnat ing said cutting and clamping members in lined relation to each other, means associated with said lever ior disconnecting said clamp ing means trom said cutting means, and pen mitting the independent operation oil said cutting means by successive movement ot' said lever in a single direction, and means for releasing said clamping bar from en gagement with said locking means.

An apparatus of the character described, having in combination a trame, a clamping` bar slidalily mounted on said trame, a cutting bar slidably mounted on said frame, a lever pivotallir mounted on said frame and provided with a. plurzility oli' fingers adapted to engage said clamping and cuttingbars, a .latch to release one oi said fingers from said lever permitting the other ot' said iingers to move imlepemlcntlj,r thereof.

8. An apparatus oi the character scribed, having in combination a trame, a clamping bar slidably mounted on said ramema cutting bar slidably mounted on said frame, a lever pivotaily mounted on said trame and provided with a plurality of fingers adapted to engage said elinnping and cutting bars, a latch. to release one ol said lingers from said lever permitting the other 0f said iingers to move independently thereof, a screw-threaded member associated with said clamping bar, a split nut associated with said trame adapted to move said clamping bar ed with said split mit for releasing the same `from said screiv-threaded mcn'iber.

Signed by me this 9th daiT ot December, 1926.

forwardly and means connectf Mil ilil 

